The Dr. Robert Bree Collaborative Meeting. January 21 st, :30pm 4:30pm

Transcription

1 The Dr. Robert Bree Collaborative Meeting January 21 st, :30pm 4:30pm

2 Agenda November 20th Meeting Minutes and Revised Bylaws Approve minutes Approve revised bylaws Addiction and Dependence Treatment Report and Recommendations Adopt Report and Recommendations Bree Implementation Team Update Coronary Artery Bypass Surgery Bundled Payment Model Approve Roster Membership Spotlight: CHI Franciscan Health Hospital Readmission Measures Update The Plan for a Healthier Washington Slide 2

3 November 20th Meeting Minutes Slide 3

4 Bylaws Page 11 Slide 4

5 Bylaws Page 12 Slide 5

6 Bylaws Page 13 Slide 6

7 Bylaws Page 16 Slide 7

8 Opportunity for Public Comment Slide 8

9 Welcome New Bree Member Paula Lozano MD, MPH Assistant Medical Director, Department of Preventive Care Group Health Cooperative Slide 9

10 Addiction and Dependence Treatment Tom Fritz ADT Workgroup chair, Retired, Previously CEO, Inland Northwest Health Services January 21 st, 2014

11 Substance Use Disorder Screening, Brief Intervention, Brief Treatment, Referral to Treatment Primary, Prenatal, Emergency Room Settings Slide 2

12 Workgroup Members Name Title Organization Tom Fritz (Chair) Chief Executive Officer, Bree Member Inland Northwest Health Services Charissa Fotinos, MD, MS Deputy Chief Medical Officer Health Care Authority Linda Grant, MS, CDP Director Evergreen Manor Tim Holmes, MHA Vice President of Outreach Services and Behavioral Health Administration MultiCare Ray Chih-Jui Hsiao, MD Co-Director, Adolescent Substance Abuse Program, First Vice President of the WSMA Seattle Children s Hospital Scott Munson Executive Director Sundown M Ranch Rick Ries, MD Associate Director University of Washington Addiction Psychiatry Residency Program Terry Rogers, MD CEO, Bree Member Foundation for Health Care Quality Ken Stark, MEd, MBA Director Snohomish County Human Services Department Jim Walsh, MD Addiction Medicine, Family Medicine w/obstetrics Swedish Observers Zosia Stanley, JD, MHA Policy Director, Access Washington State Hospital Association Slide 3

13 Public Comment Survey 53 respondents to online survey plus additional ed comments Slide 4

14 Other Psychologists (2) Washington State Society for Clinical Social Work Family therapist (addictions), legislative committee member of the Washington State Society of Clinical Social Work Washington Advocates for Patient Safety Maternal Fetal Medicine care provider WA Coalition Clinical researcher (2) Non-profit Healthcare Advancement Organization Specialty Treatment Providers Outpatient Pain & Addiction specialist Private, non profit: harm reduction emphasis 3rd party employer rep Non-Profit Association Case manager/rn in Aging and Long Term Care Chemical Dependency Treatment Facility (2) Slide 5

15 Problem Statement 93% agreed with recommendation problem statement (4% no; 4% neutral) Changes: Alignment with DSM-5 Substance use disorder definition Clear definition as chronic, relapsing-remitting disease Added prenatal care settings throughout More clearly defined scope of work Not recommending specific treatment modalities Not recommending changes to areas outside of the medical system (e.g., criminal justice) Expanded definition of drugs to include and medical purposes Added discussion of SB 6312 and HB 2572 (integration of mental health, chemical dependency, and primary care) Clear discussion of benefit of SBIRT to impact those at low levels of use Slide 6

16 Substance Use Disorder Framework Slide 7

17 Reduce stigma associated with alcohol and other drug screening, intervention, and treatment 81% agreed with recommendation 1 (6% no; 13% neutral) Changes: Added culturally competent Clear definition as chronic, relapsing-remitting disease Slide 8

18 Reduce stigma associated with alcohol and other drug screening, intervention, and treatment Train health care staff how to have non-judgmental, empathetic, culturally competent, and accepting conversations about alcohol and drug misuse Train health care staff on the prevalence of alcohol and other drug misuse, the impact of alcohol and other drug misuse on other health conditions, and the importance of screening for alcohol and other drug misuse Increase the number of people who see alcohol and other drug misuse screening as a usual part of care and are comfortable discussing alcohol and other drug misuse as a chronic, relapsing-remitting disease on a continuum Slide 9

19 Increase appropriate alcohol and other drug use screening 81% agreed with recommendation 2 (9% no; 9% neutral) Changes: Clearly state we are not recommending a specific tool Changed screening for those over 13 (age of consent for treatment) from 12 Added acknowledgement of common occurrence of other mental health diagnoses (e.g., anxiety, depression) Recommend that patients be screened as appropriate for anxiety and depression, but discussing screening, intervention, and treatment for these co-occurring disorders in more detail is out of the scope of this document Added discussion of screening pregnant women and screeners validated for pregnant women. Added that older adults may need special consideration Slide 10

20 Increase appropriate alcohol and other drug use screening Increase the number of appropriately trained staff who utilize an evidence-based screening tool Increase annual alcohol and other drug misuse screening, starting with an initial primary care visit, using a validated, scaled screening tool Implement universal alcohol and other drug misuse screening in primary, prenatal, and emergency rooms (ER) Slide 11

21 Increase capacity to provide brief intervention and/or brief treatment for alcohol and other drug misuse 85% agreed with recommendation 3 (9% no; 13% neutral) Changes: Added Provide pregnant women misusing alcohol or other drugs with coordinated, wrap-around care with involvement of appropriate primary, addiction, obstetric, and pediatric providers Slide 12

22 Increase capacity to provide brief intervention and/or brief treatment for alcohol and other drug misuse Increase the number of appropriately trained staff who provide brief intervention and/or brief treatment in the primary, prenatal, and ER settings Increase the number of patients who screen positive for alcohol and other drug misuse who receive appropriate brief intervention and/or brief treatment Follow-up with patients as appropriate who have received brief intervention and/or brief treatment Manage adolescents with addictions collaboratively with child and adolescent addiction specialists, if possible Provide pregnant women misusing alcohol or other drugs with coordinated, wrap-around care with involvement of appropriate primary, addiction, obstetric, and pediatric providers Enhance ability to triage patients to appropriate level of care if not improving Increase the accessibility of consulting with qualified behavioral health providers Slide 13

23 Decrease barriers for facilitating referrals to appropriate treatment facilities 87% agreed with recommendation 4 (8% no; 6% neutral) Changes: Added discussion of SB 6312 and HB Recommendations are meant to acknowledge the limitations of the current system; recommend steps to improve health care quality, outcomes, and affordability; and support mental health, chemical dependency, and primary care integration in Washington State Added aspirational goals, not recommendations (e.g., patients would be able to detoxify in one facility and then transfer to another chemical dependency treatment facility) Slide 14

24 Decrease barriers for facilitating referrals to appropriate treatment facilities Increase the number of patients who screen positive who are referred to and receive care at an appropriate chemical dependency treatment facility consistent with the American Society of Addiction Medicine criteria Track patients as they receive appropriate recovery care Contact patients after they receive appropriate treatment to facilitate rapid return to function Increase cross-site communication and data sharing Increase chemical dependency resources sufficient to facilitate successful patient recovery for publicly and privately-insured individuals Address the workforce shortage for certified chemical dependency professionals including training, continuing education, and wages Slide 15

25 Address the opioid addiction epidemic 77% agreed with recommendation 5 (13% no; 9% neutral) Changes: Added Pregnant women using opioids should be treated according to the standard of care. Institute for Clinical and Economic Review published a well-done review of opioid management best-practices, Management of Patients with Opioid Dependence: A Review of Clinical Delivery System, and Policy Options Included Methadone, Naltrexone including extending release injectable along with Buprenorphine Added Providing opioid overdose education and offering a prescription for Naloxone to all persons at risk for having or witnessing an opioid overdose, including those prescribed opioids, using heroin, and those in their social networks as allowed for by law Added Utilizing the Prescription Monitoring Program to evaluate a patient s controlled substance history for potential risks Slide 16

26 Address the opioid addiction epidemic Decrease inappropriate opioid prescribing for non-cancer, non-terminal pain Increase capacity for primary care providers to prescribe medication assisted treatment (e.g., increase Buprenorphine, Methadone, Naltrexone including extending release injectable, treatment availability) Train appropriate primary care and emergency room staff to screen, engage, and facilitate both onsite opioid medication assisted treatment and/or facilitate coordinated care with offsite specialized chemical dependency treatment. Extend state and private capacity and support for opioid medication assisted treatment Facilitate referrals and decrease barriers to opioid addiction treatment (specialized vs on-site addiction treatment) Track changes to the number of admissions, cost, morbidity, and mortality in emergency room, hospital, and outpatient settings (including prenatal) for patients using opiates to evaluate change over time Provide opioid overdose education and offer a prescription for Naloxone to all persons at risk for having or witnessing an opioid overdose, including those prescribed opioids, using heroin, and those in their social networks as allowed for by law Utilize the Prescription Monitoring Program to evaluate a patient s controlled substance history for potential risks Slide 17

27 Stakeholder-Specific Recommendations Added changes made to the five focus areas (e.g., prenatal care, culturally competent training) Added Train staff how to do a 42 CFR part 2 compliant release of information Aligned hospital recommendations with Potentially Avoidable Hospital Readmission Recommendations and emphasis on hospitals providing patient s discharge information to primary care provider or aftercare provider Health Plans contract with medical providers (e.g., primary care, prenatal, hospitals) that provide screening, brief intervention, brief treatment, and referral to treatment Slide 18

28 Opportunity for Public Comment Slide 19

29 Recommendation Adopt Addiction and Dependence Treatment Report and Recommendations Slide 20

30 BREE IMPLEMENTATION TEAM (BIT) UPDATE January 21 st, 2015 Dan Lessler, MD Chief Medical Officer, WA Health Care Authority Chair, Bree Implementation Team

31 BUNDLED PAYMENTS Assess readiness Purchasers interested, not all in same place Size is a barrier Employee population determines type of bundle wanted Third parties are providing bundled payments Need to be able to include rural providers and hospitals Identify large purchasers Identify brokers Education Materials for employers and others

32 NW HEALTHCARE PURCHASERS COALITION NWHPC: non-profit organization providing small and mid-size purchasers (employers and others) in eastern Washington and northern Idaho The opportunity to speak with a common voice Influence the delivery and cost of healthcare in this region

33 REPORT BACK FROM MEETING Participants discussed how their organizations are working to improve low back pain care Identified areas for improvement Identified barriers to improvement/contributions to fragmented care

34 CHECKLISTS

35 NEXT STEPS Goal to reduce burden of back pain and costs for care at community level Implement best practices for low back pain management with multi-stakeholder participation Educate consumers about recommended practices for low back pain management Improving general understanding of different stakeholders perspectives Complete work for organizations to make changes for 2016 benefit year

36 QUESTIONS? COMMENTS?

37 CORONARY ARTERY BYPASS GRAFT SURGERY BUNDLE AND WARRANTY PROPOSED ROSTER AND CYCLES ROBERT BREE COLLABORATIVE CABG WARRANTY AND BUNDLED PAYMENT MODEL JANUARY 21, 2015

38 DESIGN TEAM Providers 1. Bob Mecklenburg, MD, Virginia Mason, Co-Chair 2. Drew Baldwin, MD, Virginia Mason 3. Bob Herr, MD, US HealthWorks 4. Vinay Malhotra, MD, Cardiac Study Center (WSMA) 5. Susan Hecker, MD, St. Joseph 6. One member from WSMA 7. Two member from WSHA Purchasers 1. Kerry Schaefer, King County, Co-Chair 2. Marissa Brooks, SEIU Healthcare NW Benefits 3. AlaskaAir 4. Starbucks 5. Boeing Health Plans 1. Dan Kent, MD, Premera 2. Regence Quality Organizations 1. Susie Dade, Washington Health Alliance 2. Jeff Hummel, MD, Qualis Health 2

39 1. A WARRANTY FOR CABG Aligning payment with safety 3

40 2. BUNDLED PAYMENT MODEL Aligning payment with quality 4

41 FEATURES OF THE BUNDLE 1. Clinical standard explicitly and transparently defined 2. Content supported by transparent evidence appraisal 3. Appropriateness standards integrated into care pathway 4. Market-relevant quality measured/reported by providers 5. Financial accountability for complications as per warranty 5

42 BUNDLE: FOUR COMPONENTS EACH SEQUENTIAL COMPONENT IS REQUIRED 1. Document disability despite conservative therapy 2. Ensure fitness for surgery 3. Provide all elements of high-quality surgery 4. Facilitate rapid return to function 6

43 RECOMMENDATION Approve Draft Roster 7

44 CHI Franciscan Health

45 Who We Are Hospitals St. Joseph Medical Center, Tacoma St. Francis Hospital, Federal Way St. Clare Hospital, Lakewood St. Elizabeth Hospital, Enumclaw St. Anthony Hospital, Gig Harbor Highline Medical Center, Burien Harrison Medical, Bremerton & Silverdale Regional Hospital, Burien / 2

46 Who We Are Medical Groups Franciscan Medical Group Clinics in Pierce, King, Kitsap counties Harrison HealthPartners Clinics throughout Kitsap, Mason, Jefferson and Clallam counties Hospice and Palliative Care In-home and inpatient care 20-bed Hospice House / 3

47 Who We Are CHI Franciscan Health Family 12,100 employees * 2,346 medical staff members** Affiliated with Catholic Health Initiatives * Includes Highline, Harrison, and Regional ** End of fiscal year 2014 / 4

48 Catholic Health Initiatives One of largest Catholic health systems in U.S. Based in Englewood, Colorado 96 hospitals in 18 states Non-profit / 5

49 Catholic Health Initiatives Large System Benefits Nationally integrated network of medical expertise Sharing of best clinical practice Access to research and clinical trials Diversity of perspectives-faith-based, community and academic Purchasing power Access to capital Project management Broader industry access connected to national boards for certification Advocacy / 6

50 Sisters of St. Francis Founded St. Joseph Hospital in 1891 Compassionate care Faith-based Mission-focused Modern facilities Innovative technologies St. Francis of Assisi / 7

51 Our Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities. / 8

52 Our Vision We are the Puget Sound s first choice for healing of mind, body and spirit. / 9

53 Our Values Reverence Integrity Compassion Excellence We fulfill a sacred trust to care for those in need and to support each other. / 10

54 Our Strategy Pillars Best Place for Health and Healing Best Place to Work and Practice Best Access to Care Best Stewardship / 11

55 Creating Healthier Communities Community Benefit: We provided $95.2 million of free and subsidized programs in fiscal year 2014 Charity Care: We provided $25.4 million in free and reduced-cost care in fiscal year 2014 We serve all who need care regardless of ability to pay / 12

56 Who We Are Major Service Lines Cancer care Cardiovascular care Diagnostic imaging Neurosciences Orthopedics and sports medicine Women s care Primary care, including urgent care / 13

57 Who We Are Other Key Clinical Services Surgical weight loss Emergency care, including Level II Trauma at St. Joseph Stroke care Dialysis / 14

58 Who We Are Virtual Health Services Franciscan Virtual Urgent Care Available 24/7 Phone or virtual visit First to offer service in Pacific Northwest Clinical Operations Center Dedicated location for patient monitoring Improves access to specialists and skilled clinical staff Reduces lengths of stay and mortality Lower costs through consolidation / 15

59 Who We Are Leadership Change /

60 Questions?

61 POTENTIALLY AVOIDABLE HOSPITAL READMISSIONS REPORT AND RECOMMENDATIONS GINNY WEIR BREE COLLABORATIVE PROGRAM DIRECTOR JANUARY 21 ST, 2015

62 WORKGROUP CHRONOLOGY Draft Proposal to Bree Collaborative 3/19/14 Revised proposal presented to Bree Collaborative 5/21/14 Recommendations Approved 7/17/14 4/23/14 Workgroup meeting framing a three pronged recommendation 5/29/14 6/20/14 Public Comment Period 6/30/14 Workgroup meeting to review public comments, make further revisions 2

63 RECOMMENDATIONS SUMMARY 1. Endorsement of the Washington State collaborative model 2. Endorsement of tools and techniques to reduce readmissions in Washington State 3. Measurement: % inpatients diagnosed with acute myocardial infarction (AMI), heart failure (HF), community acquired pneumonia, chronic obstructive pulmonary disease (COPD), and stroke for which there is: 1. Patient discharge information 2. Follow-up phone call 3

64 RECOMMENDATION 1 COLLABORATIVE MODEL Collaboratives will be recognized by: Formally writing a charter that includes a list of participating organizations, shared expectations for best practices, and measures of success. Demonstrating evidence of participation in recurring meetings. Recognition by the Washington State Hospital Association (WSHA) or Qualis Health as an active member. WSHA or Qualis Health will recognize collaboratives for a period of one year after which time the organizations will reevaluate their roles. Ideally, will work to follow the Institute for Healthcare Improvement s collaborative model. 4

65 RECOMMENDATION II ENDORSEMENT OF STATEWIDE TOOLS AND TECHNIQUES Acknowledgement of community initiatives to reduce potentially avoidable hospital readmissions and support for the continuation of this work. The Washington State Hospital Association: Transitions Toolkit Care Qualis Health s data reports and technical assistance The Washington Health Alliance work to increase data transparency Hospitals adopt the Toolkit in its entirety. It is understood that some variation may be appropriate based on clinically compelling reasons. 5

66 RECOMMENDATION III: MEASUREMENT MEDICAL DISCHARGE SUMMARY Medical discharge summary consistent with The Joint Commission (preliminary acceptable if noted on document) or another form of documentation including: The reason for hospitalization The care, treatment, and services provided The patient s condition and disposition at discharge Provisions for follow-up care Pending test results Medications on discharge 6

67 RECOMMENDATION III: MEASUREMENT FOLLOW-UP PHONE CALL Documentation of a discharge phone call to patient or caregiver within three days after discharge. If patient or care provider unavailable, documentation of attempt as consistent with the hospital s protocol (e.g., call three times) Numerator: Number of inpatients with diagnosis of AMI, HF, community acquired pneumonia, COPD, or stroke for which there is a documented follow-up phone call and discharge information provided to the primary care provider (PCP) or aftercare provider within three days of discharge. Denominator: Total number of inpatient discharges with AMI, HF, community acquired pneumonia, COPD, or stroke. 7

68 WHERE ARE WE NOW COLLABORATIVE MODEL Qualis Health Many communities developed charters over past years New QIO contract starting August requires recruitment of communities in year one representing at least 15% of State s Medicare population Subset for racial/ethnic disparities Aggressive timeline as part of QIO contract to recruit communities representing increased % each year with 60% by year four Qualis has recruited three communities representing 29% of the state with charters 8

69 QUALIS HEALTH COMMUNITY MAP 9

70 Readmissions Update Bree Collaborative January 21,2015 Carol Wagner, Senior Vice President Patient Safety

71 27.0% reduction in rate. 11,700 fewer patients readmitted, saving $112 million.

72 WSHA Safe Table Collaboratives Best Practices National Experts WSHA Care Transitions Toolkit Strategies Creating Change National Experts WSHA/Qualis Health Community Work Pay-for-performance Transparency UCL CL=10.3 L Washington State Hospital Association Readmissions per 1,000 Medicare Beneficiaries Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q 2013 Readmissions per 1,000 Eligible Medicare Beneficiaries UCL CL LCL

73 Total Number of Patient Harms Avoided

74 Numerous Pay-for-Performance Exist Patient Protection and Affordable Care Act - Penalties or Rewards In 2015, excessive 30-day readmissions up to 3% of revenue by the CMS. The value-based purchasing program rewards or penalizes hospitals up to 1.5% of Medicare revenue based on a suite of quality indicators. New % penalty on all Medicare revenue if a hospital falls into the bottom quartile in performance on HACs.

75 Numerous Pay-for-Performance Exist

76 Numerous Pay-for-Performance Exist Medicaid Quality Incentive Discharge Information and Follow-up Phone Call Percent of inpatients with diagnosis of acute myocardial infarction (AMI), heart failure (HF), community acquired pneumonia, chronic obstructive pulmonary disease (COPD) and stroke for which there is: The patient s discharge information is provided to the primary care provider (PCP) or aftercare provider within three business days of discharge, and A documented follow-up phone call after discharge within three business days.

77 Numerous Pay-for-Performance Exist 30 Day All Cause Readmissions

78

79 UCL CL=10.3 L Washington State Hospital Association Readmissions per 1,000 Medicare Beneficiaries Leverage Points for Next Change Will be Different for the Next Improvement Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q 2013 Readmissions per 1,000 Eligible Medicare Beneficiaries UCL CL LCL Definition: Number of Readmissions per 1,000 Eligible Medicare Beneficiaries

80 Vision: Everyone in Washington State will receive care that honors personal values and goals at the end-of-life. Know your Options

81 Successful strategies helping those will less ability to help themselves.

82 Working Together for a Healthier Washington Presented by Dan Lessler, Chief Medical Officer, Health Care Authority January 21, 2015

83 Healthier Washington: Better Health, Better Care, Lower Costs Goal A Healthier Washington: The Healthier Washington project builds the capacity to move health care purchasing from volume to value, improve the health of state residents, and deliver coordinated whole-person care. Planning State Innovation Models Pre-Test State Health Care Innovation Plan Authority Legislation Enacted E2SHB 2572 Purchasing reform, greater transparency, empowered communities 2SSB 6312 Integrated whole-person care Implementation SIM Test $65 million four-year grant to make the Innovation Plan a reality

84 Healthier Washington: Better Health, Better Care, Lower Costs By 2019, a Healthier Washington will: Shift 80 percent of health care purchasing from paying for volume to paying for value. Have integrated physical and behavioral health services in Medicaid that serve the whole person. Will see engaged communities driving local health innovation and partnering with the state on health purchasing.

85 Systems Working Together for a Healthier Washington Education Crisis Intervention Housing Nutritious Food Public Health Employment Built Environment Criminal Justice Transportation Family Support Physical Health Substance Abuse Mental Health Whole Person Long-Term Care Oral Health Community Information Technology Measurement Consumer Engagement Financing & Administration Workforce Development Practice Transformation Health & Recovery System Supports

86 Strategies, Investments and Goals

87 Community Empowerment and Accountability North Sound North Central King Pierce SW WA Greater Columbia Accountable Communities of Health (ACHs) will: Provide a multi-sector voice for delivery system reform, shared health improvement goals and regional purchasing strategies. Serve as a forum for regional collaborative decision-making to accelerate health system transformation, focusing on social determinants of health, clinical-community linkages, and whole person care. Accelerate physical and behavioral health care integration through financing and delivery system adjustments, starting with Medicaid.

88 Practice Transformation Support Washington will develop a Practice Transformation Support Hub to help providers: Work collaboratively to achieve better health, better care and lower cost Coordinate care Adapt to value-based payment Practice Transformation also includes innovative consumer engagement initiatives, a flexible approach to workforce, and better linking of clinical and community resources.

89 Payment Redesign Model Test 1: Early Adopter of Medicaid Integration Test how integrated Medicaid financing for physical and behavioral health accelerates delivery of whole-person care Model Test 2: Encounter-based to Value-based Test a value-based alternative payment methodology in Medicaid for federally-qualified health centers and rural health clinics and pursue new flexibility in delivery and financial incentives for participating Critical Access Hospitals Model Test 3: Puget Sound PEB and Multi-Purchaser Through existing PEB partners and volunteering purchasers, test new accountable network, benefit design and payment approaches Model Test 4: Greater Washington Multi-Payer Test integrated finance and delivery through a multi-payer network with a capacity to coordinate, share risk and engage a sizeable population

90 Analytics, Interoperability and Measurement A consistent set of measures for health performance Common measures set completed January 2015 to inform purchasing strategy Enhance information exchange capacity to support care delivery, clinical-community linkages and improved health Bolster analytic capacity at state and community levels

91 Lead agency Project Management

92 Opportunities to Participate Join the Healthier Washington Feedback Network Sign up at: NOTE: If you signed up for the State Health Care Innovation Plan Feedback Network, you are already signed up. Visit the website for: Information on ACHs and regional discussions Performance measures Purchasing activities Implementation updates

93 For more information contact the Healthier Washington Team Phone: Internet: Thank you!

94 The Dr. Robert Bree Collaborative Meeting

95 Thank you, Steve Hill Slide 2

96 Wednesday, March 18, :30-4:30pm Seattle Central Library Slide 3